For Latinos, Ideas About ‘Quality Healthcare’ Need to Evolve

By Alfredo Santana, Exclusive to EGP

Miguel Angel Chavez was born with “crooked” feet.

Now 36-years-old, he’s already endured two reconstructive surgeries to try to correct the problem. Today, Chavez makes no bones about the pain he suffers daily, or his need for medication just to keep walking.

Chavez lives in Pico Rivera but travels once a month to a clinic in Highland Park where he receives ongoing treatment for the problem with his legs and feet. He also gets help dealing with a past brush with drug abuse.

His problems can be traced back to the chronic pain caused by his birth defect, he told EGP. “I was three months old when I had my first foot surgery,” he explains, adding he was two-years-old before he started to walk.

Miguel Angel Chavez is glad his Medi-Cal plan covers treatment for the pain in his legs, a pre-existing condition. (EGP Photo Alfredo Santana)

“I tell my doctor that my feet hurt and ask him to give me pain medication,” said Chavez, explaining his doctor listens but must still be convinced he needs the pain medication to get by.

According to Chavez, he has never used orthopedic devices to alleviate his pain, but does wear high-top leather boots to support his ankles and shins, a practice he says tires out his legs.

Born in Twenty-Nine Palms, CA., Chavez said he is blessed Medi-Cal has paid for almost all his medical procedures — despite his bouts with opiates and alcohol.

He thanks Obamacare for expanding his health coverage, which has made it easier to get care despite his pre-existing condition.

“I’m not into politics and I am a Christian, ” points out Chavez, a reference to the ongoing efforts by Republicans and some conservative, right-leaning groups to dismantle President Obama’s landmark expansion of healthcare. “ But I think Obamacare is wonderful: It has helped me a lot,” he told EGP.

Chavez’ story is just one of the many examples of people who now have medical insurance coverage and are trying to get it to work for them in a way they think best meets their need.

Healthcare providers are now being challenged to meet those expectations, some of which are long-rooted in what patients like Silvia Nuevo think quality healthcare looks like.

Nuevo’s three children attend Richard Riordan Primary Center on Monte Vista Street in Northeast Los Angeles. She told EGP she takes each of them for a medical checkup at least once a year. Nuevo said she doesn’t worry about taking them to the doctor when they catch the flu or some other illness because they have Medi-Cal.

In her view, her children are getting the right care if the doctor prescribes an antibiotic or some other type of medicine.

“I tend to expect the doctors to give them medicine, or a prescription. That’s what I think” they should do, said the Highland Park resident in Spanish. She wants her children to stay healthy and if she thinks the doctor is doing a poor job, she’ll find another one.

According to health experts, most Latino patients expect doctors to give them a prescription for medicine if they are sick, either to take in the doctor’s office or at home.

The Affordable Care Act, commonly known as Obamacare, has expanded coverage to thousands of low-income Latinos who can now afford to receive medical care at clinics and hospitals.

While the increased number of younger Latinos with coverage is being celebrated, medical professionals say they are still struggling to change patients’ attitudes toward prescription drug and alcohol consumption.

A study conducted by the Kaiser Family Foundation released in July reported that 68% of all eligible Californians are enrolled in Covered California — the healthcare marketplace exchange run by California’s Department of Healthcare Services — compared to only 58% insured when the first round of enrollments opened in 2014.

The survey, titled “California’s Previously Uninsured After the ACA’s Second Open Enrollment Period,” reported that 88% of all the insured receive subsidies to help them pay for their policies.

Peter Lee, executive director of Covered California, said these figures clearly show that Obamacare is working as intended in California.

In 2014, Covered California subsidized 348, 938 residents in Los Angeles County alone, excluding Medi-Cal recipients. Across the state, 200,261 Mexican-Americans received some form of subsidy, compared to 2,745 Puerto Ricans and 1,537 Cuban-Americans. People of mixed ancestry totaled 8,647.

Covered California reported that 28% of all new enrollees this year identify as Latino, including 228,766 who signed up for private insurance plans. Half of the 311,741eligible enrollees, who did not pick a coverage plan before the Feb. 15 deadline, self-identified as Latino, according to Covered California.

The question remains, however, does having health insurance change people’s habits when it comes to when and where they get their care, or what they expect doctors to do for them?

In Chavez’ and Nuevo’s cases, the answer would appear to be no.

Young adult and adolescent Latino patients, particularly those born in this country, have stubborn mindsets about prescriptions, but don’t always get want they want.

In addition to a heavy school load, many young Latinos have to work to contribute to their families’ finances, and some will succumb to the stress and pressure from friends at parties, where they’ll mix drugs and alcohol.

Dr. Martha Rivera, a pediatrician who sees young adults at Optimal Healthcare Center in Boyle Heights, said family interaction is an important part of achieving a better health balance for youth who suffer from anxiety, and may self-medicate with drugs and alcohol.

“I do integrated medicine, which includes prevention and nutrition and many of my patients walk out without prescriptions,” Rivera said. “Instead, I tell them to avoid medical marijuana or more and more medicine,” the doctor explained. “I teach them relaxation [techniques] to avoid chemical imbalances. We are getting back to basics.”

Rivera said most of the 35-40 patients she sees a day are under 21: on Oct. 1, she will open a new office where she will see more adults.

“I mostly see patients with Medi-Cal, who pay out of their pocket for the cost of medicine when they get prescriptions, like Tylenol. They pay with cash. They find out it’s better to do that than to go to McDonald’s,” Rivera said about her effort to change their way of thinking. “Most find Obamacare very confusing,” she said, but “want to find out how it works.”

Obesity rates among young Latinos is high, which puts them at higher risk for cardiovascular diseases and diabetes, the doctor said.

Rivera, whose clinic is within the White Memorial Medical Center complex, said she recently started a series of health classes to encourage Latino parents to vaccinate their offspring early and to improve nutrition and preventive care among youth and adults.

“We really want to avoid fatty foods in the Latino culture. I know that is difficult, knowing how adults and people think within the Latino culture, but we need to do it,” Rivera stressed.

Meanwhile, Hector Flores, a physician who heads the family medicine program at White Memorial, says adult immigrants feel at ease when they visit a doctor who understands their language and many of their cultural traits.

Flores said many patients expect their healthcare providers to guide them through the insurance process, including finding a primary physician, but will still resort to going to the emergency room when sick even though they have purchased private healthcare policies.